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Health Issues for Aging Populations Instructors: Lynda Burton, Sc.D. Bruce Leff, M.D. Overview of Class, 2007
Biological Basis and Clinical Aspects of Aging Physiologic changes Loss of homeostatic reserve Increased vulnerability to disease Comorbid conditions Life expectancy Maximum life span potential-- --upper limit to human life? Theories to explain process of aging
Demography of Aging Effect of fertility, mortality, migration Demographic imperative 13% of population in 1990s 24% in 2030 increase in number of oldest old Aged dependency ratio: 38 persons age 65 and over per 100 persons aged 18-64
Figure 1: Number of Persons 65+, 1900-2030 (numbers in millions) 80 70 60 50 40 30 20 10 0 71.5 54.6 40.2 35 31.2 25.7 16.7 9 3.1 4.9 1900 1920 1940 1960 1980 1990 2000 2010 2020 2030 Year (as of July 1) A profile of Older Americans: 2006, AOA, US, DHHS
Physical Disorders Associated with Aging Normal aging versus disease Chronic illness Prevalent diseases Diseases associated with health care use, mortality
Mental Disorders of Older Persons Dementia, depression, delirium most prevalent Prevalence of dementia in nursing homes: 40-67%; community 4-5% 4 Implications for costs of care Behavior problems associated with dementia Risk factors
Functional Capacity and Disability Measurement of health status number of diseases severity health services utilization functional capacity Measurement of functional capacity
10 9 8 7 6 5 4 3 2 1 0 Projected Disabled Population longer life, higher disability constant 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Preventive Health for Older Persons Primary, secondary and tertiary prevention Preventive services Life style change Physical activity Diet Smoking, excessive alcohol intake Psycho-social, social, self-mastery
Total Life Expectancy, Active Life Expectancy and Disabled Life Expectancy Piedmont Health Survey of the Elderly; Women, Age 65 White Women Total Life Expectancy Low Education 15.2 2.6 17.8 High Education 18.0 3.0 21.0 Black Women Low Education 15.6 2.7 18.3 High Education 19.5 3.3 22.8 0 5 10 15 20 25 Active life expectancy Disabled life expectancy Data Source: Guralnik, et al. Educational status and active life expectancy among older blacks and whites. New Engl J Med 1993;329:110.
Health Services for Older Persons: Ambulatory Ambulatory visits: Chronic care follow up hypertension, chronic obstructive pulmonary disease, diabetes, congestive heart failure Preventive care Integrated, coordinated care
Health Services: Hospital Care About 3,549 hospitalized per 10,000 persons age 65+ Trend toward decrease in days 5.8 days, Problems with hospitalizing older persons cascade iatrogenesis New types of hospital services Role of managed care in reducing hospitalizations
Health Services: Community-based and institutional long-term care Home health care: acute vs long term Adult day care Hospice New services Continuing Care Retirement Communities Assisted Living (Board and Care) PACE, SHMOs Institutional care
Psychosocial Aspects of Health and Aging Issues for family caregivers Who are they? How do you define caregiver burden? How do you measure it? Does this burden affect health, mental health? Research to relieve caregiver burden Changing roles of older persons Sense of control, self-mastery Social isolation
Federal Health Policies Related to Older Persons Medicare Benefits, adding prescription drugs Reimbursement to providers Medicaid Long-term care PACE, SHMO
State Health Policies Related to Older Persons Regulatory policy Nursing homes Assisted living CCRCs Financing of care Move to managed care nursing home payment PACE-type programs
Ethical Issues in Providing Health Care to Older Persons Principles: beneficence, autonomy, justice, non-malfeasance Informed consent for care, research Equal access to resources vs. rationing Issues surrounding death and dying, long-term care
Data Sources for Study of Health of Older Persons Claims data (Medicare and Medicaid) Interview data Medical records Encounter data Hospital discharge summaries National Long-term Care Survey National Nursing Home Survey
Data Sources for Study of Health of Older Persons, continued Medicare Current Beneficiary Survey Medical Expenditure Panel Survey